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Primary care trusts bring out mixed emotions in social care professionals: some fear it will mean a health service takeover, others believe they offer a new era of joint working. Terry Philpot talks to some of the social care chiefs put in charge of trusts and how they see the future of social work.

When Liam Hughes left his post as strategic director of Bradford social services department in January, some people were surprised at his move to his new job as chief executive of the East Leeds Primary Care Trust. But not Hughes, as there is a thread running through his career that makes this new job an obvious culmination of what has gone before.

A qualified psychiatric social worker, Hughes' experience of working with mentally ill and older people had brought him into close contact with health professionals almost from the start of his career. He also worked in the resettlement programmes set up to move people with learning difficulties from long-stay hospitals, which brought him experience of housing as well as health. In 1980, when most social services departments were still giving grants to the voluntary and private sectors for services, he was working at Barnet - an authority that was using contracts.

Hughes is unsentimental about modern social services departments, which were created by the Seebohm report in 1968. He sees them as a by-product of the failings of the NHS and education, and thought the report itself was flawed. He makes no predictions about the future. The most he will say is that it is "probable" that care trusts will be the structure of the future. But in response to what is now becoming the social care question: "Will social services departments be here in five years' time?" he says no. He qualifies that by saying that it is difficult to see where all social services departments' functions will be in five years' time.

Social work, he says, would have to be invented if it didn't exist. Social services departments do not correspond with natural synergies - their mental health work has more in common with that of the NHS than, say, their work with children in care. But if care trusts do come, Hughes says, "there's a paradox in that they will work best where least needed and worst where they are needed the most - because in some places it will be the end of a process of working together. They are less likely to be successful where they are imposed."

Partnership, he says, is as much about what you are willing to give up as about what you take. Many of the GPs and nurses he knows are not antipathetic to the holistic model that social work promotes.

He sees the vast responsibilities of a really responsive primary care trust as being to ensure social well-being as well as good health care, being involved with social care, neighbourhood renewal, preventive work, local strategic partnerships, the voluntary sector and regeneration. They will be responsible, too, for integrating services with social services and for tackling health inequalities. Primary care trusts have "incredible potential" says Hughes. Boil this down and you have PCTs in the vanguard of creating consistent standards across the country, underpinned by National Service Frameworks.

Hughes came to Bradford in 1995 and, as he puts it, "I didn't want to spend my last years making an orderly retreat from Seebohm to whatever else was coming along."

But the opposite has happened: he's now in the advance guard.

After our initial conversation, Julia Ross, with her unique portfolio as director of social services at London Borough of Barking and Dagenham, and chief executive of the local PCT, telephones me. "I am not doing two jobs - I am doing one and that's improving health and social care, and I don't think you can do one without the other," she says.

Ross has reason to feel at home where she is. She qualified as a general nurse before switching to social work and then chose psychiatric social work - she had worked briefly as a psychiatric nurse - and, later, hospital social work. These two jobs were, and in many ways still are, closer to working in health care.

In Scotland, she became deputy director of social services of the former Lothian region and then moved to London as director of social services for Hillingdon. She did a two-year stint as an independent consultant working on family law reform in the Lord Chancellor's Office, and then came to Barking and Dagenham in 1998 as director to get the department off special measures. She took the PCT job in April 2001.

Barking and Dagenham has its virtues. It is a comparatively small and compact area and the PCT and the local authority have coterminous boundaries. It is also an area in need of regeneration. This, thinks Ross, makes her dual responsibilities well matched.

She believes that social services departments have probably reached the end of their usefulness (with some solid achievements, she stresses, behind them) but she's not dogmatic about the future. Indeed, perhaps it is a sign of the flux in which health and social care find themselves that, prompted to say what the future looks like, she's hard put to do so.

What she comes out with is an organisational spectrum that runs from all-embracing care trusts - "the health takeover" - at one end, and still extant but far fewer social services departments at the other. In the middle is the Barking and Dagenham model. Her ultimate hope is that her two job titles will merge into one, with all posts being joint.

Ross says she always thinks of social services as a service and not as a department. It is possible that in some areas, she says, the function will remain separate, evolving and coexisting with education, housing and health by "very good liaison and a lot of working together at the interface".

And as if to prove her belief that having two titles to manage two agencies is really one job, she insists that if she hadn't persuaded those who appointed her to the PCT that she should also be director of social services, she would have taken the trust job and tried to persuade them by other means. And if she hadn't taken the job? Then, eventually, she says, she would have gone elsewhere where her ideal could have been realised.

Perhaps it is a sign of how much joint working between health and social services exists already that Graeme Betts says that it didn't seem strange to "step over". In fact, that was one reason why he took the job as chief executive at Hillingdon PCT in October 2001.

Betts had worked in joint commissioning, developed joint planning structures and had been involved with the modernising programmes for mental health and learning difficulties at Hillingdon social services department. The other reason for applying for the Hillingdon post was, as he puts it, that "although there is a lot of joint working, the feeling is that health is where it's at and it is where the innovative work is taking place".

He spent three years at the top in Hillingdon as well as spells as a manager and a researcher elsewhere in London boroughs and as a joint planning officer for Lewisham and Lambeth Health Authority.

The situation into which we are now moving, says Betts, begs questions about the local authority as a provider of services. He is certain that, in five years' time, social services departments will have ceased to exist.

But in a future without the departments, social services will bring to the new arrangements an attachment to user involvement, and experience of performance management, commissioning and Best Value. In fact, Betts goes on to say that he notices even now that the language of the PCT is now very often the language of social services. He points out that the now oft-scorned Seebohm report was talking about working with the community more than 30 years ago.

Betts counts the solid achievements to date as being an even split of PCT and local authority funding; radically reformed accommodation services for people with learning difficulties; the integration of speech, language and occupational therapy services; and the integration from this April of what are currently three locally based community mental health teams.

Betts says:"Social care is not just a social services issue, it is a council issue and if people don't grasp that, then they do not understand the situation. People need to think in terms of health and social care provision and not the social services department or the PCT. If you think in those terms it therefore makes sense to think of creating strategic jobs."

If there is a discernible trend in the way things are going in social care, Sue Ross expresses it most concisely: "I have never been committed to the maintenance of social services departments. But I am committed to the role of social work."

Ross says this from the perspective of having moved in June 2001 from director of social work, East Renfrewshire, where she had been for six years, to become chief executive of the York PCT after a career in social services.

She also thinks that health needs social care's skills and insights but, as she puts it, health is not begging social care to join it. What social care needs, she says, is self-confidence - more so in England than Scotland. And it must demonstrate its value.

She also says:"Social work ought to be able to exist in any organisation. Whether it is, say, a health or housing setting isn't important - what is important is that social work should be there. The question is if you put social work alongside professions that are seen to be more powerful (like medicine), will they lose out? It is not inevitable - it depends on the quality of what they offer.

"If you go to the other end of the spectrum, people who receive services do not care who delivers them but rather whether the services meet their needs. If we were in Northern Ireland [where there are joint health and social care trusts], we wouldn't be discussing the future of social services departments. We wouldn't regard what we had as offering difficulties."

Ross is anxious for social work to demonstrate its valuable role in multidisciplinary teams, its "unique" perspectives on community and the family and skills in assessment. Unfortunately, she says, underspending on the standard spending assessment means that some other professionals never have contact with a social worker.

Ross applied for her job out of curiosity - the PCT post was advertised in Community Care, so she reasoned that the trust must be interested in someone other than a health professional. She saw, too, that it would offer a vast range of services by a wide variety of professionals.

She also remains uncertain about whether social services departments will survive. At one point she thinks not; at others she thinks they may exist in some form in some places, in others not at all. Of East Renfrewshire, she says: "I didn't join health by leaving a sinking ship. I left a high-performing department that will continue for many years to come." But she doesn't look back on the creation of social services and social work departments as some ideal organisational era.

She also doesn't foresee too many problems with the move from democratic control by local government to unelected trusts. Councillors, she says, never had the control over social services that they did over some services, and she thinks that the new role of local representative, advocate and scrutineer is one which suits the new world of health and social care.